Dr. Mercola has just posted an article about a theory and training developed by Dr. David Hanscom, an orthopaedic spine surgeon. After 15 years of chronic pain, he diagnosed himself with neurophysiologic pain and cured himself by expressive writing – getting out on paper all his negative feelings.
Naturally, I was interested and started, as we all do, with Google and could find no hits for neurophysiologic disorder. I then looked up emotional brain and pain and found an interesting article on PubMed – which confirmed my feeling that my pain had been misdiagnosed all along.
This stressed the difference between stimulus evoked pain (mechanical pain like arthritis) and spontaneous pain, where the nervous system just keeps on firing (chronic pain). And they noted that both patients and doctors confuse the two:
“stimulation from the activities of daily life occurs very many times a day and that these stimulus-evoked pains may give a fluctuating level of daily pain that both patients and investigators mistake for spontaneous pain.”
Aha! That infuriated feeling when what you have been saying all along – and has been brushed aside – is right!
How many of us have had our pain firmly, and mistakenly, diagnosed as chronic, with the implication of emotional problems? My GP, when she apologized for not referring no me earlier to a pain clinic, said, “I find my patients want their pain.” A help book tells the families of pain parents to ignore their distress, which is labeled 'pain behaviour.' “Even if they are rolling on the floor in agony, just step over them,” it advises cosily.
All the way through, I have been contesting the diagnosis of chronic pain because I wake every day pain-free. My pain doesn't start till I move, until I bend forward to brush my teeth. I do not have spontaneous pain, where the switch gets stuck and pain continues long after the site has healed. I have stimulus-evoked pain, created each day by normal movements, similar to someone needing a hip rekacement.
Dr. Hanscom's argument is based on fMRI research showing that, after several years, brain activity of people with chronic pain moves away from sensory to emotional processing. He found that when he wrote out his emotions, his pain resolved, so now he is teaching his patients expressive writing.
Am not sure about the logic. How do you explain people who have had pain for more than a year, have a knee replacement and pain stops? According to theory, after a year the pain would be operating from the emotional brain with no incentive to stop.
I think we must differentiate between true spontaneous pain, which is constant and continues long after the person has healed, and stimulus evoked pain. Expressive writing may help with spontaneous pain, where the switch gets stuck, but not when it is mechanical (stimulus evoked).
Also what about the many people whose emotions are festering sores, but they don't have pain? His pain resolved, but he didn't just have back pain, but migraine, skin rashes, tingling feet, ringing in the ears and post-traumatic stress disorder. Can one fairly extrapolate from his case the conclusion that his solution fits all?
I am not surprised that the emotional bran is engaged as a result of the changes and limits that daily pain produces. The nuts and bolts of living with pain day after weary day change the way one responds. It is no longer coping with the physical pain, but also trying to build a possible life when doors are slamming shut around you – a meaningful life.
Lady Tebbit, who was paralyzed by a bombing attack at a Conservative Party Conference, spoke afterwards about coming to terms with her situation and said it was nowhere near as difficult as her lifelong battle with depression. Would it be surprising if the brain's preoccupation shifted from the mechanics of pain to the emotional effort of coping?
Dr. Hanscom may have found a way to help some patients, but I think he has given many more yet another stick to beat themselves with.
Spine Surgeon Reveals Roadmap out of Chronc Pain by Dr. Mercola – link
Journal of Pain: What is Spontaneous Pain and Who Gets it? – link
FMRI Research on chronic pain – link